Embedding automatic and gradual budgetary adjustments in Social Security and Medicare would substantially lessen the risk of runaway federal debt. Implementing these adjustments would be more complex in Medicare than in Social Security. The first step should be to inject more discipline into Medicare by modifying its Supplementary Medical Insurance trust fund. A second step should be to eliminate fragmentation in the insurance benefit. With these changes, Congress could balance automatic adjustments between revenue and spending parameters and manage spending by imposing more restraint on payments to service providers and higher costs for beneficiaries. Ensuring permanent Medicare trust fund stability would be consistent with the program’s original design and would lessen the frequency and intensity of divisive solvency-restoration debates.